Regenerative Medicine: A Holistic Approach for Musculoskeletal Disorders
Numerous forms of regenerative medicine exist today. From a musculoskeletal perspective the first step should embrace the importance of nutrition. While several procedures are available to enhance cell regeneration, none of them will be as effective if the body is nutritionally deficient. While numerous supplements are available, we recommend Juice Plus. This is a whole food fruits and vegetable extract with several medical school studies that demonstrate Juice Plus absorption and cell integration of the underlying nutrients.
Before regenerative medicine techniques are initiated it is best to have a medical doctor evaluate the root cause of the problem. Often underlying conditions are present that affect healing. For example, a patient with diabetes or early peripheral arterial disease will not heal as quickly as someone without those conditions. Medical management to obtain optimal control of co-morbid disease can only enhance a regenerative medicine approach.
Likewise, a torn rotator cuff in the shoulder or an osteoarthritic knee may be associated with a strained ligament in the neck or a nerve irritation in the low back. Quite often treating the spinal component will improve the results of treating the injured limb. That means the whole body should be evaluated, not just the area of most obvious interest. If muscles are inhibited, tight or weak a functional restoration program to re-educate, stretch and then strengthen should occur.
Diagnostic Musculoskeletal Ultrasound, Segmental Plethysmography, and Arterial Duplex studies are three non-invasive and non-ionizing tests that can both image and detect the presence of injury or disease. Depending upon the severity of findings results can be used to formulate a focused treatment plan. Prolotherapy is a very powerful tool to re-grow, or proliferate, torn or stretched muscle, tendon and ligament as a first line of defense.
Prolotherapy is a technique where medications are injected into an injured musculoskeletal body part with the intent of regenerating tissue. Various compounds are used, but we prefer a combination of Xylocaine and 50% dextrose or P2G. When injected into the injured body part, proliferative injections pull your own growth factors to the area (like a paper towel absorbing water), which in turn initiates the wound healing cascade.
Essentially Prolotherapy is a natural way of telling your body’s natural wound healing response to come to an area and to it. Injections are often done an average of three times over a several weeks. Biopsies have been done and confirm the creation of organized tissue (not scar formation). After the third injection a 40% thickening can be expected.
For more severe cases, or in instances where a faster response is needed, PRP can be done. In this instance Platelet Rich Plasma (concentrated growth factors from your own blood) are injected into the injured tissue. Unlike prolotherapy that tells your body’s natural wound healing response to come to an area, PRP concentrates those cells involved in wound healing and puts them into the area. Usually only one or two injections are needed. While there can be more pain right after the injection it is usually short lived and followed by rapid improvement.
Placed in between PRP and stem cell therapy are concentrated growth factors that are obtained from donor sources such as amnion (the inner most layer of the placenta) or from the placenta itself. While some biologic companies that provide placenta derived growth factors have studies that suggest their products contain stem cells, claims from this class of products are restricted to containing growth factors only.
Exosomes are not just growth factors; they are also thought include facilitators and initiators, and anti-inflammatory agents. They are vesicular messengers that are extruded by stem cells. They are the signally agents that are thought to be behind why stem cells work. Because their anti-microbial and anti-inflammatory properties may reduce the chances of infection and diminish pain, and their anti-adhesion properties may reduce and prevent scarring, it has been suggested that they may one day be useful for regenerative medicine applications.
The FDA closely monitors the process whenever biologics such as these are used to help assure that strict safety standards are met. Furthermore, new stringent FDA Guidelines must be met effective January 1, 2020. These Guidelines state that allografts (tissue harvested from someone else) or other biologics (such as exosomes) must meet new homologous use criteria. In a nut shell, the Guidelines spell out that only minimal manipulation of the host tissue is allowed, and that it’s function at the graft site should be like and similar to what it was doing before.
Wharton’s jelly, the viscus material inside umbilical cords, has also gained favor in some audiences as possibly an ideal musculoskeletal regenerative medicine product. If the FDA determines it meets the requirements for homologous use, since it seems to have many of the favorable characteristics needed for orthopedic conditions, then this too could be a promising treatment.
No discussion of regenerative medicine options today would be complete without some discussion of the difference between allografts and autologous grafts. Whenever the host tissue comes from someone different than where it is put back, it is referred to as an allograft. Examples include as amnion, exosomes, umbilical derived Wharton’s jelly, or umbilical derived cord blood Stem Cells.
This is in contrast to Autologous grafting where the host and donor are the same person. Examples of autologous grafts include PRP, bone marrow and fat (adipose) derived stem cell harvesting. There are many technical differences between allografts and autologous grafts, however allograft treatments do not require surgery, are relatively easier to administer, cause little pain during the procedure. Allografts are also, for the most part, clearly labeled regarding exactly what was actually isolated in the harvest and made available for re-implantation. Having said that, autologus harvesting of bone marrow aspirate followed by re-implantation for orthopedic conditions such as degenerative joint disease, appears to be the most studied and homologous regenerative medicine technique today. In addition, homologus bone marrow aspirate grafts have been applied for well over a decade now and have an excellent safety record.
When considering which regenerative medicine approach is best for you at Piedmont Physical Medicine and Rehabilitation, PA we like to help you and your body do whatever is necessary to facilitate the best outcome. That means we try to look at all the factors that affect wellness and consider whatever else is necessary to support your musculoskeletal system and the joint or tissue we are trying to treat.
Some patients may benefit from nutritional support, treatment with hormone replacement therapy, infectious and immunological approaches, or addressing other challenges. We understand that one size does not fit all when it comes to your health care. We try to be open minded in our approach, and are happy to tailor a treatment plan that makes the most sense for you.